Effectiveness of Surgery for Lumbar Spinal Stenosis : A Systematic Review and Meta-Analysis

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Effectiveness of surgery for lumbar spinal stenosis

Background: The management of spinal stenosis by surgery has increased rapidly in the past two decades, however, there is still controversy regarding the efficacy of surgery for this condition. Our aim was to investigate the efficacy and comparative effectiveness of surgery in the management of patients with lumbar spinal stenosis. Methods: Electronic searches were performed on MEDLINE, EMBASE, AMED, CINAHL, Web of Science, LILACS and Cochrane Library from inception to November 2014. Hand searches were conducted on included articles and relevant reviews. We included randomised controlled trials evaluating surgery compared to no treatment, placebo/sham, or to another surgical technique in patients with lumbar spinal stenosis. Primary outcome measures were pain, disability, recovery and quality of life. The PEDro scale was used for risk of bias assessment. Data were pooled with a random-effects model, and the GRADE approach was used to summarise conclusions. Results: Nineteen published reports (17 trials) were included. No trials were identified comparing surgery to no treatment or placebo/sham. Pooling revealed that decompression plus fusion is not superior to decompression alone for pain (mean difference -3.7, 95% confidence interval -15.6 to 8.1), disability (mean difference 9.8, 95% confidence interval -9.4 to 28.9), or walking ability (risk ratio 0.9, 95% confidence interval 0.4 to 1.9). Interspinous process spacer devices are slightly more effective than decompression plus fusion for disability (mean difference 5.7, 95% confidence interval 1.3 to 10.0), but they resulted in significantly higher reoperation rates when compared to decompression alone (28% v 7%, P < 0.001). There are no differences in the effectiveness between other surgical techniques for our main outcomes. Conclusions: The relative efficacy of various surgical options for treatment of spinal stenosis remains uncertain. Decompression plus fusion is not more effective than decompression alone. Interspinous process spacer devices result in higher reoperation rates than bony decompression

Lpd depletion reveals that SRF specifies radial versus tangential migration of pyramidal neurons

During corticogenesis, pyramidal neurons (~80% of cortical neurons) arise from the ventricular zone, pass through a multipolar stage to become bipolar and attach to radial glia[superscript 1, 2], and then migrate to their proper position within the cortex[superscript 1, 3]. As pyramidal neurons migrate radially, they remain attached to their glial substrate as they pass through the subventricular and intermediate zones, regions rich in tangentially migrating interneurons and axon fibre tracts. We examined the role of lamellipodin (Lpd), a homologue of a key regulator of neuronal migration and polarization in Caenorhabditis elegans, in corticogenesis. Lpd depletion caused bipolar pyramidal neurons to adopt a tangential, rather than radial-glial, migration mode without affecting cell fate. Mechanistically, Lpd depletion reduced the activity of SRF, a transcription factor regulated by changes in the ratio of polymerized to unpolymerized actin. Therefore, Lpd depletion exposes a role for SRF in directing pyramidal neurons to select a radial migration pathway along glia rather than a tangential migration mode.Ruth L. Kirschstein National Research Service Award (grant F32- GM074507)National Institutes of Health (U.S.) (grant # GM068678

Educação no trabalho na atenção primária à saúde: interfaces entre a educação permanente em saúde e o agir comunicativo

O trabalho em saúde e a educação no trabalho constituem-se com uma dupla dimensão - ação instrumental e intersubjetividade. OBJETIVO: Analisar as concepções de educação que fundamentam as atividades educativas de trabalhadores da saúde na atenção primária. MÉTODO: Estudo de abordagem qualitativa realizado em duas unidades básicas de saúde do município de São Paulo, por meio de entrevista semiestruturada gravada com 36 informantes-chave, representativos de cada categoria profissional dos serviços, incluindo o segmento gerencial e o de trabalhadores da saúde. Os dados foram analisados com a técnica de análise de conteúdo temática com base no quadro teórico: processo de trabalho em saúde, teoria do agir comunicativo, educação continuada (EC), educação permanente em saúde (EPS) e integralidade, os quais permitiram a construção das categorias empíricas: educação instrumental/tradicional e educação comunicativa/emancipatória. Resultados: Os resultados mostram o predomínio da concepção de educação no trabalho como construção coletiva do saber a partir da realidade de trabalho, pertinentes à EPS que se pretende instituir para a mudança das práticas e do modelo assistencial biomédico. Contudo, alguns depoentes expressam uma concepção de educação instrumental com ênfase em ações técnicas e de atualização do saber, que se aproxima da EC. CONCLUSÃO: Os resultados evidenciam a convivência das duas concepções de educação de trabalhadores - instrumental e comunicativa com o predomínio da segunda, que mostra a capilaridade da política de EPS entre os trabalhadores de saúde das UBS e a necessidade de aprofundar o debate para consolidar a prática educativa no cotidiano de trabalho.Health work and work education are a double dimension - instrumental action and intersubjectivity. OBJECTIVE: To analyze the conceptions of education that support educational activities of health care workers in Primary Health Care. METHOD: This qualitative study was conducted in two primary health care units (PHCU) in São Paulo, through semi-structured interviews with 36 key informants representing each professional category, including managers and health care workers. Data were analyzed based on thematic content analysis and on the theoretical framework: the healthcare work process, theory of communicative action, continuing education (CE), permanent education in health (PEH) and integrality (comprehensive approach), which allowed the construction of the empirical categories: instrumental/traditional education and communicative/emancipatory education. RESULTS: The results show the prevailing notion of work education as a collective construction of knowledge from the reality of work, relevant to the PEH that is intended to be introduced in order to change the practices and the biomedical health care model. However, some interviewed subjects expressed an instrumental conception of education that emphasizes technical actions and knowledge updating, which is closer to CE. Conclusion: Results show the coexistence of the two conceptions of workers' education: instrumental and communicative, with the predominance of the second one, which shows the reach of the PEH policy among the health workers of PHCU and the need for deepening the discussion to consolidate educational practice in daily work

Long-Lasting Efficacy of Radio Electric Asymmetric Conveyer Neuromodulation Treatment on Functional Dysmetria, an Adaptive Motor Behavior

BackgroundFluctuating asymmetry (FA) is widely defined as the deviation from perfect bilateral symmetry and is considered an epigenetic measure of environmental stress. Rinaldi and Fontani hypothesized that the FA morpho-functional changes originate from an adaptive motor behavior determined by functional alterations in the cerebellum and neural circuits, not caused by a lesion, but induced by environmental stress. They called this phenomenon functional dysmetria (FD). On this premise, they developed the radio electric asymmetric conveyer (REAC) technology, a neuromodulation technology aimed at optimizing the best neuro-psycho-motor strategies in relation to environmental interaction.AimsPrevious studies showed that specific REAC neuro postural optimization (NPO) treatment can induce stable FD recovery. This study aimed to verify the duration of the NPO effect in inducing the stable FD recovery over timeMaterials and methodsData were retrospectively collected from a population of 29,794 subjects who underwent a specific semiological FD assessment and received the NPO treatment, regardless of the pathology referred.ResultsThe analysis of the data collected by the various participants in the study led us to ascertain the disappearance of FD in 100% of the cases treated, with a stability of the result detected up to 18 years after the single administration of the REAC NPO treatment.ConclusionsThe REAC NPO neurobiological modulation treatment consisting of a single administration surprisingly maintains a very long efficacy in the correction of FD. This effect can be explained as the long-lasting capacity of the NPO treatment to induce greater functional efficiency of the brain dynamics as proven in previous studies

The burden of mental disorders, substance use disorders and self-harm among young people in Europe, 1990-2019 : Findings from the Global Burden of Disease Study 2019

Background Mental health is a public health issue for European young people, with great heterogeneity in resource allocation. Representative population-based studies are needed. The Global Burden of Disease (GBD) Study 2019 provides internationally comparable information on trends in the health status of populations and changes in the leading causes of disease burden over time. Methods Prevalence, incidence, Years Lived with Disability (YLDs) and Years of Life Lost (YLLs) from mental disorders (MDs), substance use disorders (SUDs) and self-harm were estimated for young people aged 10-24 years in 31 European countries. Rates per 100,000 population, percentage changes in 1990-2019, 95% Uncertainty Intervals (UIs), and correlations with Sociodemographic Index (SDI), were estimated. Findings In 2019, rates per 100,000 population were 16,983 (95% UI 12,823 - 21,630) for MDs, 3,891 (3,020 4,905) for SUDs, and 89.1 (63.8 - 123.1) for self-harm. In terms of disability, anxiety contributed to 647.3 (432 -912.3) YLDs, while in terms of premature death, self-harm contributed to 319.6 (248.9-412.8) YLLs, per 100,000 population. Over the 30 years studied, YLDs increased in eating disorders (14.9%;9.4-20.1) and drug use disorders (16.9%;8.9-26.3), and decreased in idiopathic developmental intellectual disability (-29.1%;23.8-38.5). YLLs decreased in self-harm (-27.9%;38.3-18.7). Variations were found by sex, age-group and country. The burden of SUDs and self-harm was higher in countries with lower SDI, MDs were associated with SUDs. Interpretation Mental health conditions represent an important burden among young people living in Europe. National policies should strengthen mental health, with a specific focus on young people. Funding The Bill and Melinda Gates Foundation Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)Peer reviewe